A
watershed moment has arrived for many families: This week health care
workers from CVS and Walgreens, under contract from the federal
government, will fan out to nursing homes across the country to begin
vaccinating residents against the coronavirus. The shots not only will
help protect the nation’s elderly and infirm — and the staff who care
for them — but they raise the prospect of ending the devastating
isolation many residents have felt for months.
Family
members are hopeful that before too long, they will return to visiting
parents and grandparents, aunts, uncles and other loved ones regularly
again. We checked with experts on some common questions.
Will restrictions on visiting be lifted soon?
Probably
not in a big way. Restrictions vary by state, and the federal
government’s guidance on what it considers safe stands for now. They
already allow visits under certain conditions. The Centers for Medicare
& Medicaid Services, or C.M.S., recommended in September that
outdoor visits with residents be allowed and indoor visits, too, if the
facility has been free of cases for 14 days.
Some
medical experts have said that those guidelines are too lax and that
visits should be severely restricted, even banned. However, some of
these experts are now saying that the vaccine changes the equation,
somewhat.
“Once all residents are vaccinated, it opens the door for loosening of
restrictions,” said Dr. Michael Wasserman, the immediate past president
of the California Association of Long Term Care Medicine, a geriatrician
and former executive at nursing home chains.
To allow visits, Dr. Wasserman recommends all residents of a nursing
home should be vaccinated (unless they have some condition or allergy
that would discourage vaccination on medical grounds); all staff members
should be vaccinated; and the nursing home should have the ability to
ensure that visitors test negative for the coronavirus and have been
disciplined about wearing a mask in public settings.
Is the vaccine safe and effective for old and frail residents of nursing homes?
The
clinical trials of the Pfizer and Moderna vaccine included people over
65, and results showed it to be safe and to work as well in older people
as in younger ones.
“This vaccine has
gone through testing and clinical trials to ensure it meets the highest
safety standards. It also is safe to get if you already had the virus,” says a campaign to
encourage people to get the shots by the American Health Care
Association and National Center for Assisted Living, a combined trade
group representing nursing homes and assisted-living communities.
The
lead administrator for C.M.S., Seema Verma, reinforced the confidence
in the shot for older patients, including those with health conditions,
in a statement last week: “I urge states to prioritize nursing homes and
vulnerable seniors in their distribution of the vaccine.”
The point is echoed by Dr. Sabine von Preyss-Friedman, chief medical
officer of Avalon Health Care Group, which operates nursing homes, who
said the new vaccines appear “safe and effective.”
If restrictions are eased, should I visit right away?
The
Pfizer and Moderna vaccines both require two injections — the initial
shot and a booster three or four weeks later. Dr. von Preyss-Friedman
recommends waiting at least two weeks after the second shot to have a
visit.
“You hope these vaccines work, but these are elderly patients,” she said. “You want to err on the side of protection.”
She
said that, ideally, the visitor would also be vaccinated as well. Since
shots won’t be widely available for a few months, it may be best to
wait until you get your vaccine. Until then, she believes nursing homes
should consider visits on a case-by-case basis.
Would visitors still need to wear a mask?
Absolutely,
medical experts said. This is particularly true if they are not
vaccinated, but even after they are vaccinated “until rates in the
community go down,” said Dr. Joshua Uy, a geriatrician and associate
professor at the University of Pennsylvania Medical School and the
medical director of Renaissance Healthcare & Rehabilitation Center, a
nursing home in Philadelphia.
Dr. Uy
said that he hopes that the federal government would supply enough
personal protective equipment so that all visitors and residents could
be properly gowned for such visits.
What is being done to encourage nursing home residents to get vaccinated?
The combined nursing-home and assisted-living trade group has started a program aimed at helping nursing homes
and other care facilities to explain to residents the essential need to
get the vaccine. The campaign, #getvaccinated, notes: “The elderly
population has a much higher risk for getting very sick, being
hospitalized, or dying from Covid-19. The vaccine has been shown to
provide a great deal of protection against serious illness due to
Covid-19.”
But the people
they love most may have more effective persuasive powers. Families can
help, Dr. Uy said, by encouraging their parents and grandparents in
nursing homes to get vaccinated.
“The vaccine,” he said, “is going to be our way out.”
